Nearly 13 percent of front-line staffers at the Wilmington VA Medical Center say they were ordered or felt pressured to enter a different appointment date than that requested by a veteran patient, according to those surveyed in a May audit of 900 VA facilities, further details of which became public Monday.

The practice of manipulating waiting times allows a center to report that it is setting a higher percentage of appointments within 14 days, VA's own standard of an acceptable wait to be seen.

That finding, and others, give further credence to charges of schedule-shifting leveled by three clinicians who have worked in the Wilmington VA system. They told the News Journal in May that the problems have been created by a combination of staff reductions over the years, an influx of new patients since 2010, and a desire to meet patient-care goals set by higher headquarters.

The finding that 12.5 percent of Wilmington staffers had altered appointment dates was lower than that reported at several of the other nine facilities examined in its region, known as Veterans Integrated Service Network 4. At the facility at Clarksburg, W. Va., for instance, 53.3 percent of staffers said they felt such pressure. The average response throughout VISN 4 was 17.86.

In another practice being investigated by the VA Inspector General at Wilmington and at least 41 other facilities, 7.69 percent of Wilmington staffers they were aware of non-approved means of recording appointment requests - that is, outside the approved electronic system.

Such practices would ease altering the date of a vet's initial request to make it seem as though an appointment was scheduled within VA's own standard of 14 days from the requested date, allowing a facility to send more encouraging reports to its region, the IG has found.

By comparison, 41 percent of staffers at the Pittsburgh VA hospital said they were aware of the practice, and 32 percent said they actually track appointments in such a manner.

Manpower issues contribute to Wilmington's appointments issues. A "lack of provider slots" makes it difficult for veterans to get timely appointments at the center more than three-quarters of the time, front-line staffers told auditors.

In addition, staffers said scheduler staffing is "an issue" with regard to giving veterans timely access to care more than half the time - rating it a 3, or "sometimes," on a scale of 1-5, with 5 representing "always."

In response to a cryptically worded question, "Are there other obstacles to being able to provide Veterans timely access to care?", 62.5 percent of staffers said yes.

And in a concluding note to the VISN 4 portion of the audit, auditors noted that the site "reports lack of education, training, and mentoring for scheduling clerks and clinic managers. There were allegations of delayed consults that were reported to upper level management with no actions."

The audit sought to determine whether allegations about inappropriate scheduling practices that first came to light at the Phoenix VA Medical Center were isolated instances of improper practices, or if more systemic problems existed. The broader, less detailed findings were released in early June; the specific findings at 54 VA facilities, including Wilmington, were released Monday.

The audit results, some of which were made public in June, were shared with the VA's Inspector General. The IG's findings have yet to be released.

The Wilmington findings were drawn from a five-day survey of 38 facilities within VISN 4. Auditors interviewed a total of 174 front-line staffers.

Auditors acknowledged several limitations to their work in the region. First was a "high sensitivity to feedback for identifying potentially improper practices - cannot distinguish between deliberate deception versus confusion about policy." The auditors also noted that pressure to get the work done meant little time to test the survey itself and to train site visit teams. The audit's "massive scope and scale" also "precluded independent verification of individual statements," which demanded further investigation "to substantiate initial findings of potential malfeasance."